一例N3受累、最初无法切除的上沟肿瘤患者在接受化疗和杜伐单抗治疗后进行了挽救性手术。

Takehiko Manabe, Masatoshi Kanayama, Hiroki Matsumiya, Katsuma Yoshimatsu, Masataka Mori, Natsumasa Nishizawa, Akihiro Taira, Masaru Takenaka, Koji Kuroda, Koichi Azuma, Fumihiro Tanaka
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引用次数: 0

摘要

背景化疗后使用杜伐单抗(PACIFIC 方案)可为不可切除的 III 期非小细胞肺癌(NSCLC)提供良好的治疗效果。一些研究报告了 PACIFIC 方案后进行挽救性手术的可行性,但其疗效仍不明确。我们在此介绍首例对N3受累的上沟肿瘤采用PACIFIC方案后进行挽救性手术并获得病理完全反应的病例:一名53岁男性患者,左上沟肿瘤N3(# 1L,# 4R)受累(腺癌,临床T3N3M0/IIIC),在前一家医院接受了同期化放疗(2个周期的顺铂加维诺雷宾与60 Gy放疗),随后接受了为期1年的durvalumab治疗。PACIFIC方案使原发性肿瘤明显缩小(直径从3.1厘米缩小到0.5厘米),所有结节的18F-氟脱氧葡萄糖摄取消失。PACIFIC 疗程结束 6 个月后,只有原发肿瘤出现增大(直径从 0.5 厘米增至 2.0 厘米)。因此,怀疑肿瘤局部复发。患者接受了抢救性手术(左上叶切除术,联合胸壁切除术[第1至第4肋骨])。组织学检查显示没有存活的肿瘤细胞(ypT0N0M0)。抢救性手术后 7 个月,患者仍然存活,没有肿瘤复发的迹象:本病例表明,对上沟肿瘤采用 PACIFIC 方案后,可行挽救手术。长期随访对确定挽救手术的疗效至关重要。
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A case of salvage surgery following chemoradiotherapy and durvalumab for initially unresectable superior sulcus tumor with N3 involvement.

Background: Durvalumab after chemoradiation (PACIFIC regimen) provides favorable treatment outcomes for unresectable stage III non-small cell lung cancer (NSCLC). The feasibility of salvage surgery after the PACIFIC regimen has been reported in some studies; however, its efficacy remains unclear. We herein present the first case of salvage surgery after the PACIFIC regimen for a superior sulcus tumor with N3 involvement, in which a pathological complete response was achieved.

Case presentation: A 53-year-old man with a left superior sulcus tumor with N3 (# 1L, #4R) involvement (adenocarcinoma, clinical T3N3M0/IIIC) underwent concurrent chemoradiotherapy (2 cycles of cisplatin plus vinorelbine with 60 Gy radiotherapy) followed by durvalumab treatment for 1 year at a previous hospital. The PACIFIC regimen provided a significant primary tumor shrinkage (diameter 3.1 cm to 0.5 cm) with the disappearance of 18F-fluorodeoxyglucose uptake in all nodes. Six months after the end of the PACIFIC regimen, only the primary tumor showed enlargement (diameter 0.5 cm to 2.0 cm). Accordingly, local tumor recurrence was suspected. Salvage surgery (left upper lobectomy with combined chest wall resection [1st to 4th rib]) was performed. The histological examination revealed no viable tumor cells (ypT0N0M0). At 7 months after salvage surgery, the patient remains alive with no signs of tumor recurrence.

Conclusions: The present case suggests that salvage surgery may be feasible after the PACIFIC regimen for superior sulcus tumors. A long-term follow-up is essential to determine the efficacy of salvage surgery.

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